From a warm welcome to a follow-up appointment

Where: DePaul Hospital, a 450-bed community hospital in St. Louis, Mo.

The issue: Improving patient satisfaction with hospitalist care.

Background

In 2010, Press-Ganey surveys indicated to Sarada Sripada, MD, FACP, that DePaul patients
weren't very satisfied with their hospitalists. “The patient satisfaction [scores]
for medical floors and the hospitalists working on the medical floors were very low
compared to other physicians, like surgeons and OB-GYN doctors,” said Dr. Sripada,
practice group leader of the IPC The Hospitalist Company group at DePaul. Specifically,
the patient satisfaction on one hospitalist floor scored in the first percentile.

The hospital administration was eager to improve these statistics, and Dr. Sripada
had recently received training in quality improvement as a member of the inaugural
class of the Fellowship for Hospitalist Leadership program created by IPC and the
University of California, San Francisco. For the fellowship's required quality improvement
project, she set out to improve patient satisfaction on the low-scoring floor.

“I chose this floor where all the patients are elderly patients going to the
nursing homes and patients who need a lot of pain medications,” Dr. Sripada
said. “I thought there were a lot of process deficiencies on that floor.”

How it works

The process changes start right at admission, with a “warm welcome.”
Dr. Sripada explained: “Whenever a patient reaches the floor, there will be
an announcement that the new patient arrived. The charge nurse and another two nurses
go there right away and arrange whatever the patient needs right away.”

Better communication is a major focus of the improvements she implemented. The hospitalists
now make it a point to educate patients about their disease processes and inform them
about the clinical plan for the day, writing down necessary information on a whiteboard
in the patient's room.

That educational effort is followed up by nursing staff. “The nurses go back
in the afternoon and ask them questions—a teachback about the disease process—so
they understand the problems they are having and they can handle it better after they
go home,” Dr. Sripada said.

To further improve post-discharge care, the hospital team—which includes case
managers and social workers—also arranges follow-up appointments and outpatient
medication. “The hospital's outpatient pharmacy helped us out in filling their
prescriptions. All of their medications will be delivered to their rooms before they
leave the hospital,” said Dr. Sripada.

But the biggest change, Dr. Sripada said, is the implementation of multi-disciplinary
rounds, with the physician, nurse, social worker and case manager all seeing the patient
at the same time every day to cooperate on the plan of care. “That made a lot
of impact on the process,” she said.

Results

The impact was measured in the floor's Press-Ganey results. Patient satisfaction with
the nurses, hospitalists and discharge process had increased to above the 90th percentile
by September 2011.

Anecdotally, the satisfaction also spread to the clinical staff. “All the physicians
and the nurses are really happy and they're satisfied with what they're doing for
the patients,” Dr. Sripada said.

Challenges

That's not to say there wasn't any pushback when the changes were first implemented.
“It's a change in the culture of the hospital,” said Dr. Sripada. Better
communication can take a little more time upfront, she acknowledged. But the team
found that the initial investment saved time in other areas.

“Our phone calls from the nurses actually decreased a lot. The nurses know
what's going on with the patients and they can communicate better with the patients
and the families,” she said.

Next steps

After the changes were found to be successful on the pilot floor, they were implemented
elsewhere. “We started with one floor and we spread it throughout the hospital,”
said Dr. Sripada. “There are five or six hospitals in the system, and we are
spreading out to other hospitals.”

She also plans additional study of the effects of the changes. “Our next project
is readmissions,” she said. “By doing this, we are expecting readmissions
to be decreased, because patients are educated about the disease process and all of
the follow-up appointments are made.”

ACP Hospitalist provides news and information for hospitalists, covering the major issues in the field. All published material, which is covered by copyright, represents the views of the contributor and does not reflect the opinion of the American College of Physicians or any other institution unless clearly stated.